Coronary heart diseases (CHD) represents an insidious process that starts in early life and progresses steadily throughout the years until manifested by one or more conditions. Essential hypertension is one of the major risk factors for the occurrence of CHD. The conventional risk factors like dyslipidemia, obesity, diabetes mellitus, anxiety and stress are responsible for hypertension and cardiovascular disorders. Unless the risk factors associated with CHD are managed. It is not possible to prevent the incidence of CHD.
The prevention and management of coronary risk factors includes prevention of occurrence of CHD risk factors before clinical manifestation of CHD and management of coronary risk factors after clinical manifestation. Several studies are in support that by managing the hypertension and reducing the lipid levels the incidence of CHD can be minimized.
There is ample evidence to prove that hypercholesterolemia and hypertriglyceridemia have positive correlation with atherosclerosis, CHD and stoke. It has been observed that consumption of starch is prone to develop cardiovascular disorders due to atherogenic injury than the consuming less starch. In long course of time this alters the genetic character, rendering people with such consumption more susceptible to develop early atherosclerosis, hypertension and hyperlipidemia. Elevated serum cholesterol, LDL-c and low HDL-c are major independent conventional risk factor CHD and atherosclerotic event. High concentration of triglycerides, small dense LDL-c and low level of HDL-c is referred to as dyslipidemic and this process is responsible for insulin resistance. Insulin resistance syndrome is characterized by a number of cardiovascular risk factor like central obesity, hyperglycemia, hypertension, dyslipidemia along with pro-coagulant factors and inflammatory markers. Studies have demonstrated a significant reduction in CHD events among diabetic cases by the proper management of hypercholesterolemia.
Recent task factors inflammation and acute phase reactants circulating cytokines, hs C-reactive protein (CRP), serum albumin and fibrinogen are predictor of onset of CHD and recurrent acute myocardial infarction. Several studies have shown that elevated homocysteine (Hcy) is frequent in persons with CVD and it is strong and independent risk factors for adverse cardiac events.
Elevation of Hcy is associated with an increased risk of cardiovascular disease and the cause is deficiency of folate. One of the experimental studies reported that hyperhomocysteinemia evoked by folate depletion increases arterial permeability and stiffness. The address effect of elevated hcy level involve oxidative damage to vascular endothelial cells, increased proliferation of smooth muscle cells and high oxidized LDL-c leading to atherosclerosis. Thus, it is responsible for endothelial dysfunction. Similarly increased CRP has a major role in the pathogenesis of atherosclerosis. CRP and other inflammatory sensitive proteins are primarily related to changes in plaque morphology and possibility to rupture and acute thrombosis.
Elevated levels of circulating cytokines have been demonstrated in patients with heart failure. IL-6 concentration was related to severity of left ventricular dysfunction and to the degree of activation of the sympathetic and rennin-angiotensin systems. Thus cytokines including IL-1, IL-6 and TNF-α are responsible for the development of progression of coronary heart diseases. IL-6 is genetically determined and level determines the risk of atherosclerosis, thrombosis and CHD.
Adiponectin, is also inversely related to blood pressure, heart rate, total cholesterol, LDL-c, and triglycerides and positively related with HDL-c. It is proposed that CRP, fibrinogen, lipoprotein (a) and homocysteine are important bio-markers for assessment of CHD risk even in asymptomatic individuals with strong family history of conventional risk factors of CHD.
Recently some of the biomarkers are emerging useful in the diagnosis and treatment of the pathophysiology of cardiac disease like cardiac troponin (cTn), β-type natriuretic peptide (BNP) is a 32-amino-acid counter regulatory peptide release in response to cardiac stretch. BNP values have shown strong correlation with age and acute coronary syndrome cases. Elevated BNP is responsible for stroke, obstructive sleep apnea, diabetes, left ventribular hypertophy and stable CAD. 3CD40 legand a signaling protein was found to be significantly elevated with acute coronary syndrome.
Psychosocial stress also plays an important role in the precipitation of arterial hypertension, angina pectoris and myocardial infarction. Depression is an independent risk factor for development of CHD. Thus stress management contribute in the prevention of adverse cardiac event. Reduction in obesity index is also helpful in reducing the incidence of CHD.
Many synthetic conventional drug therapy are used such as anti-hypertensive, anti-arrhythmic, hypolipidaemic, anti-diabetic, anti-obesity, agents but their application are limited are prolonged use can produce untoward effects on biological system.